Management specificities for abdominal, pelvic and vascular penetrating trauma.

Management of patients with penetrating trauma of the abdomen, pelvis and their surrounding compartments as well as vascular injuries depends on the patient's hemodynamic status. Multiple associated lesions are the rule. Their severity is directly correlated with initial bleeding, the risk of secondary sepsis, and lastly to sequelae. In patients who are hemodynamically unstable, the goal of management is to rapidly obtain hemostasis. This mandates initial laparotomy for abdominal wounds, extra-peritoneal packing (EPP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) in the emergency room for pelvic wounds, insertion of temporary vascular shunts (TVS) for proximal limb injuries, ligation for distal vascular injuries, and control of exteriorized extremity bleeding with a tourniquet, compressive or hemostatic dressings for bleeding at the junction or borderline between two compartments, as appropriate. Once hemodynamic stability is achieved, preoperative imaging allow more precise diagnosis, particularly for retroperitoneal or thoraco-abdominal injuries that are difficult to explore surgically. The surgical incisions need to be large, in principle, and enlarged as needed, allowing application of damage control principles.

Surgical treatment of adrenal carcinoma.

Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. The presence of a mass syndrome or signs of hormonal hypersecretion often lead to its discovery, but more and more frequently, adrenocortical malignancy is fortuitously discovered as an incidentaloma. Cross-sectional imaging (CT and MRI) often points to the malignant character of the adrenal mass. Needle biopsy is contraindicated. Laboratory testing showing combined hypersecretion of cortisol, androgens or inactive corticosteroid precursors is highly suggestive of ACC. An 18F-fluoro-deoxyglucose Positron Emission Tomography (PET scan) should be performed to evaluate the malignancy of an adrenal mass and to detect regional or distant metastases. Although the majority of ACC are diagnosed at a locally advanced or metastatic stage, radical resection offers the only hope of cure. The peri-operative management of patients with ACC is not yet standardized. The aim of this review is to summarize the actual knowledge of the surgical management of ACC.

[Use of French version of Ureteral Stent Symptom Questionnaire for tolerance evaluation of ureteral double J-stent]. / Évaluation de la tolérance de la sonde JJ par l'utilisation de l'autoquestionnaire USSQ.

OBJECTIVES: To evaluate the quality of life of the holders of a ureteral double J stent (US) using the USSQ questionnaire (Ureteral Stent Symptom Questionnaire), validated in French in 2010. METHODS: Between January 2009 and December 2011, 249 patients underwent flexible ureteroscopy for urolithiais in our service. Among them, 160 received a US in perioperative, and they were sent self-questionnaire USSQ-FR retrospectively. The questionnaire includes 38 questions, concerning the perioperative period with US, and 4 weeks after its removal, grouped into 6 sections: urinary symptoms, pain, general health, professional resounding, sexual resounding, and other problems. A subgroup analysis was performed, comparing US used in emergency and planned US, active patients or retired, male or female. Statistical analysis used the Chi(2) test for paired data, the Fisher exact test and the Kruskal Wallis test. RESULTS: Of the 157 questionnaires sent (two patients who died, one mentally retarded), we obtained 80 responses. Quality of life appears to be significantly altered in all areas explored by the questionnaire. Urinary symptoms: 26.9 versus 19.9 score (P<0.0001), pain: 16.1 versus 10.7 (P=0.003), general health: 13.9 versus 9.1 (P<0.0001), professional practice: 6.1 versus 3.6 (P=0.0002), female: 3.3 versus 1.8 (P=0.001). There was no significant difference if the US was placed in emergency or programmatically, if patients were professionally active or retired. In addition, women had a significantly impaired quality of life compared to men for urinary symptoms, general health and professional practice. CONCLUSION: US are responsible for a significant impairment of quality of life for patients. The validated, self-administered, USSQ-FR questionnaire is a reliable tool for this evaluation. LEVEL OF EVIDENCE: 5.